Specialty Care Utilization Declines After US Patients Transition to Nursing Homes

Research published in the Journal of the American Geriatrics Society indicates that specialty care use decreases after US patients transition to nursing home long-term care. 

The utilization of specialty care among US nursing home residents is not well-studied, but it is believed that limited access to specialty care for these residents can lead to negative health outcomes and increased hospitalizations. This study aimed to examine patterns of specialty care utilization among LTC residents before and after their transition to nursing homes, focusing on those with previous specialty care needs and vulnerable populations. 

Researchers used the Minimum Data Set v3.0 (MDS) and a 20% sample of Medicare fee-for-service claims in 2014–2018 to study specialist outpatient visits for new long-term care (LTC) residents within 1 year before and after transitioning to a nursing home. The cohort was limited to residents with specialty care in the 13–24 months before LTC transition.  

In this study, researchers examined the proportion of residents receiving at least one visit the year before and the year after the transition were measured and subgroups of residents with a prior diagnosis likely requiring LTC. It was also noted if there was continuity of care within the same specialty care provider. 

Of 39,288 new LTC transitions from 2016-2017, 17,877 residents (45.5%) had a prior specialist visit 13-24 months before the transition. The proportion of residents with specialty visits consistently decreased in all specialties 12 months after the transition. The relative decrease ranged from 0.9% for neurology in patients with multiple sclerosis to 67.1% for psychiatry in patients with severe mental illness. About 78.9% of residents who continued seeing a specialist saw the same provider as before the transition. 

“The use of specialty care falls significantly after patients transition to a nursing home,” said researchers. “Further research is needed to understand what drives this drop in use and whether interventions, such as telemedicine can ameliorate potential barriers to specialty care.” 

Reference  

Ulyte A, Mehrotra A, Huskamp HA, et al. Specialty care after transition to long-term care in nursing home. J Am Geriatr Soc. 2023; 71(4): 1058-1067. doi:10.1111/jgs.18129